Consumer Credit Application

TERMS OF ACCOUNT: All accounts are due and payable by the 10th of the month following purchase. A finance charge of 1 1/2% per month (annual percentage rate of 18%) will be applied to all past due accounts.

First, Middle Intitial and Last

Street or P.O. Box, City, State & Zip

Street or P.O. Box, City, State & Zip

If you have lived at your present Address for less than 2 years.

Joint Account


Please fill out the following fields if this will be a Joint Account.

First, Middle Initial, Last

How long have you worked here?

Please add First & Last name of all who qualify.

First, Last Name

First, Last Name

Agreement Terms


The above information is for the purpose of obtaining credit and I/we certify that the information is true and correct. I/we authorize you to verify this information and/or obtain additional information from a credit reporting agency. In consideration for the credit extended the undersigned agrees to be liable for all indebtedness plus any interest and/or reasonable attorney fees should any litigation be incurred for non-payment of account.

By clicking and typing your name you agree this is your legally binding signature.

By clicking and typing your name you agree this is your legally binding signature.